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Biomedical subjects

Jan Erikssen

Publications and source records attributed to Jan Erikssen.

12 recordsLinked to original sources
PubMed2005

Reasons for terminating an exercise test provide independent prognostic information: 2014 apparently healthy men followed for 26 years.

AIMS: We wanted to study whether reasons for terminating an exercise test might influence long-term mortality of healthy men, a previously unreported subject. METHODS AND RESULTS: During 1972-75, 2014 men aged 40-59, free from somatic diseases and not using drugs, underwent an examination programme including case history, clinical examination, various blood tests, and a symptom limited exercise ECG-test. The following reasons for test termination were noted: impaired breathing, lower limb fatigue, exhaustion (=combined lower limb fatigue and impaired breathing), high heart rate, abnormal blood pressure response, heart arrhythmias, increasing chest pain during exercise, marked ST-depressions during the test, and refusal to continue. Follow-up was 26 years. When adjusting for age, men who stopped exercising exclusively because of impaired breathing (n=178) had a 1.86-fold increased risk (95% CI 1.34-2.60; P=0.0002) of dying from coronary heart disease (CHD), a 1.64-fold increased risk (95% CI 1.32-2.03; P<0.0001) of dying from any cause, and a 3.47-fold increased risk (95% CI 2.24-5.12; P<0.0001) of dying from pulmonary causes compared with men having defined exhaustion (n=1376). After adjustment for age, smoking, total serum cholesterol, fasting blood glucose, systolic blood pressure, and physical fitness, impaired breathing remained significantly associated to an increased risk of dying from CHD, pulmonary disease, or any causes. CONCLUSION: Healthy men who stop bicycle exercising only because of impaired breathing have a high long-term CHD-, pulmonary-, and total-mortality, and such men may need further diagnostic scrutiny and follow-up.

Adult↗
PubMed2004

[Exercise ECG].

Exercise ECG testing is the most widely used method for detecting myocardial ischaemia, but the test is also applied in numerous other settings. The method requires close attention to technical details and application of appropriate test protocols. Attention to absolute and relative contraindications and criteria for test abortion is mandatory. In addition to the ECG, work capacity, heart rate and blood pressure responses are also important diagnostic and prognostic markers. Interpretation of the test results depends on the setting; knowledge of potential confounders is important. The diagnostic and prognostic value of the test is population-dependent. Exercise ECG testing is most valuable as a diagnostic tool for myocardial ischaemia when pretest disease probability is high.

Contraindications↗
PubMed2004

Exercise testing of healthy men in a new perspective: from diagnosis to prognosis.

AIM: It has recently been suggested that exercise testing may be more valuable prognostically than it is diagnostically in apparently healthy subjects. We wanted to compare the accuracy of CHD risk assessment based on classical risk factors with an assessment also based on multiple exercise test parameters. METHODS AND RESULTS: In 1972-75, 2014 apparently healthy men aged 40-60 had a symptom limited exercise test during a cardiovascular survey. Three hundred died from CHD during 26 years of follow-up. Compared to Cox regression models solely including classical risk factors (CRF), models also including multiple exercise test parameters (CRF+X) were clearly superior (P < 0.0001). Risk scores were computed based on the models. CRF and CRF+X risk scores often differed markedly; CRF+X scores were generally most reliable in both the high and low risk range. In smokers with cholesterol >6.5 mmol/l (n = 470), the CRF and CRF+X models identified 67 vs. 110 men at the highest CHD risk level according to European guidelines (34.2% vs. 38.2% CHD mortality). Three in five CRF+X-identified smokers with cholesterol >6.5 mmol/l had CHD mortality similar to the mean of all 2014 men. CONCLUSION: Integration of multiple exercise test parameters and conventional risk factors improved CHD risk assessment substantially--especially in smokers with high cholesterol.

Adult↗
PubMed2004

Symptom-limited exercise testing, ST depressions and long-term coronary heart disease mortality in apparently healthy middle-aged men.

BACKGROUND: Previous studies have shown that ST depressions > or =1.0 mm during or post-exercise increase long-term risk of dying from coronary heart disease (CHD), the need for coronary artery bypass grafting (CABG) or the development of acute myocardial infarction (AMI) in healthy men. In the present prospective cohort study we investigate whether less marked ST depressions may influence CHD mortality, incidence of AMI, the need for a CABG or having a non-fatal stroke. METHODS: During 1972-75, 2014 men aged 40-59 years, free from somatic diseases and not using any drugs, underwent an examination programme including case history, clinical examination, various blood tests and a symptom-limited exercise ECG-test. ECG was registered during exercise and at 30 s, 1, 2, 3 and 5 min post-exercise. The possible prognostic impact of ST-changes of 0.50-0.99 mm and > or =1.00 mm compared with normal ST-segments were studied separately and combined. Horizontal, down-sloping and slowly up-sloping ST-segment patterns were combined. RESULTS: After adjustment for age, smoking, blood pressure, cholesterol, maximal heart rate, left ventricular hypertrophy and physical fitness ST depressions > or =0.50 mm--during and/or post-exercise--were associated with a 1.47-fold [95% confidence interval (CI) 1.10-1.95], and 1.54-fold (95% CI of 1.17-2.04) increased 26 years risk of CHD-mortality, respectively. The same ST-changes also increased 22 years risk of developing non-fatal AMI or needing CABG but not developing non-fatal stroke. CONCLUSIONS: Even an ST depression > or =0.50 mm during and/or after exercise increases the long-term risk of CHD-death, developing an AMI or needing CABG. No association was found between ST-changes and incidence of non-fatal strokes.

Adult↗
PubMed2003

[Incidence and prevention of occupational electrical accidents].

BACKGROUND: The Norwegian Directorate for Fire and Electrical Safety receives an annual total of 50 reports of injuries caused by electricity, while the Labour Inspection Authority receives 150 reports. The underreporting is, however, considerable. In this article we estimate the Incidence of occupational electrical accidents and describe the legislation regulating the reporting of injuries from electrical accidents. MATERIAL AND METHODS: 326 of 343 electricians (95 %) returned a questionnaire on electrical accidents. RESULTS AND INTERPRETATION: We received reports that indicated an incidence of 7.6 serious accidents per 100 person-years, which equal more than 3000 electrical accidents annually in Norway. Underreporting complicates accident prevention. Doctors should more often report occupational accidents than what is common today.

Accidents, Occupational↗
PubMed2003

[Acute and chronic injuries after electrical accidents].

BACKGROUND: Electrical accidents are potentially fatal incidents with effect on the cardiovascular, nerve and musculoskeletal systems and on the skin (burns). The electrical engineering industry points out that the follow-up of injured persons from site of accident to hospital is quite random. This paper gives a review of the current literature and proposes guidelines for the follow-up of victims of electrical accidents. MATERIAL AND METHOD: A search of the literature was conducted on Medline, Embase, Biosis, Healthline, the Cochrane Library, the ISI citation databases, and on several other search engines. The revised guidelines were developed in consultation with 23 medical and industry institutions. RESULTS AND INTERPRETATION: Serious acute effects of electrical accidents include cardiac arrest, respiration failure, burns (also (internal burns) with necrosis of e.g. muscle tissue), injuries to the nerve system, and renal failure. Traumas caused by falls are also frequent. Possible chronic effects are mostly seen in the nerve system as encephalopathy and psychological sequelae or as spinal cord and peripheral nerve injury. Most importantly, long latent periods are possible for some chronic nerve injuries. This paper suggest guidelines for acute (on the spot) action and criteria for referral to hospital, observation in hospital and further follow-up.

Accidents↗
PubMed2003

Fasting blood glucose is independently associated with resting and exercise blood pressures and development of elevated blood pressure.

OBJECTIVE: To assess whether fasting blood glucose is independently related to blood pressure at rest and during exercise, and to development of elevated blood pressure. DESIGN: Cross-sectional and prospective cohort study of 2014 apparently healthy middle-aged men. METHODS: The baseline survey included carefully standardized blood pressure measurements at rest and during exercise testing, an intravenous glucose tolerance test and a panel of fasting blood tests, including fasting blood glucose. Results from 7-years follow-up provided data on development of elevated blood pressure. RESULTS: Strong associations were found between quartiles of fasting blood glucose and baseline resting and/or exercise levels of blood pressure, and also development of elevated blood pressure over 7 years. Physical fitness, calculated from an exercise test, had a strong modulating effect on blood pressure at all levels of fasting blood glucose. In multivariate models - after adjusting for intravenous glucose tolerance, physical fitness, age, body mass index, triglycerides and cholesterol - fasting blood glucose was strongly associated with blood pressure at rest (coefficient = 2.83, P = 0.0004) and during exercise (coefficient = 6.57, P < 0.0001), and further to development of treated hypertension and/or elevated blood pressure [odds ratio (OR), 1.17; 95% confidence interval (CI), 1.05-1.31]. CONCLUSION: In healthy non-diabetic and non-hypertensive men, strong associations were found between fasting blood glucose and blood pressure at rest and during exercise and to development of elevated blood pressure after 7-years follow-up. Fasting glucose metabolism deserves scrutiny when studying the pathogenesis of hypertension.

Adult↗
PubMed2002

Warfarin, aspirin, or both after myocardial infarction.

BACKGROUND: The role of antithrombotic therapy in secondary prevention after myocardial infarction is well established. Although the available literature suggests that warfarin is superior to aspirin, aspirin is currently the more widely used drug. We studied the efficacy and safety of warfarin, aspirin, or both after myocardial infarction. METHODS: In a randomized, multicenter trial in 3630 patients, 1216 received warfarin (in a dose intended to achieve an international normalized ratio [INR] of 2.8 to 4.2), 1206 received aspirin (160 mg daily), and 1208 received aspirin (75 mg daily) combined with warfarin (in a dose intended to achieve an INR of 2.0 to 2.5). The mean duration of observation was four years. RESULTS: The primary outcome, a composite of death, nonfatal reinfarction, or thromboembolic cerebral stroke, occurred in 241 of 1206 patients receiving aspirin (20.0 percent), 203 of 1216 receiving warfarin (16.7 percent; rate ratio as compared with aspirin, 0.81; 95 percent confidence interval, 0.69 to 0.95; P=0.03), and 181 of 1208 receiving warfarin and aspirin (15.0 percent; rate ratio as compared with aspirin, 0.71; 95 percent confidence interval, 0.60 to 0.83; P=0.001). The difference between the two groups receiving warfarin was not statistically significant. Episodes of major, nonfatal bleeding were observed in 0.62 percent of patients per treatment-year in both groups receiving warfarin and in 0.17 percent of patients receiving aspirin (P<0.001). CONCLUSIONS: Warfarin, in combination with aspirin or given alone, was superior to aspirin alone in reducing the incidence of composite events after an acute myocardial infarction but was associated with a higher risk of bleeding.

Aged↗
PubMed2002

C-reactive protein predicts death in patients with previous premature myocardial infarction--a 10 year follow-up study.

Atherosclerosis is an inflammatory disease. C-reactive protein (CRP), a marker of inflammation, is associated with coronary heart disease (CHD). We measured CRP in a cohort of 247 patients (193 males and 54 females) who had had their first myocardial infarction (MI) at age < or = 55 (males) or < or = 60 (females). The cut-off values of the 25th, 50th and 75th centiles of CRP were 1.20, 2.37 and 4.20 mg/l. After 10 years, a total of 44 patients (17.8%) had died, 36 (81.8%) of cardiac causes. Unadjusted and adjusted (i.e. for age, ejection fraction (EF), serum total cholesterol (TC), fibrinogen, smoking and hypertension) relative risks (RRs) for total and cardiac mortality were generated. CRP was a strong predictor of death of all causes due to its strength as predictor of cardiac death. The RR of cardiac death was doubled with increasing CRP quartiles, and patients in the top quartile had six times as high risk of cardiac death as patients in the lowest quartile. The RRs were moderately attenuated after adjustment, but still significant. We conclude that CRP is a strong predictor of mortality in patients with premature MI. Thus, inflammation appears to be a critical prognostic factor in patients with previous premature MI.

C-Reactive Protein↗
PubMed2002

Gender and socioeconomic status as determinants of waiting time for inpatient surgery in a system with implicit queue management.

OBJECTIVE: In a system with implicit queue management, to examine gender and socioeconomic status as determinants of waiting time for inpatient surgery, after adjusting for other potential predictors. METHODS: A cohort of 452 subjects was examined in outpatient clinics of a general hospital and referred to inpatient surgery. They were followed until scheduled hospital admission (n=396) or until the requested procedure no longer was relevant (n=56). We compared waiting time between groups from referral date until hospital admission, using Kaplan-Meier estimates of waiting times and log rank test. A Cox proportional hazards model was used for assessing the risk ratio (RR) of hospital admission for scheduled surgery. RESULTS: Gender and socioeconomic status could not explain variations in waiting time. However, patients with suspected/verified neoplastic disease or a risk of serious deterioration without treatment had markedly shorter waiting times than the reference groups, with adjusted RR (95% confidence intervals (95%CI)) of time to receiving in-patient surgery of 2.3 (1.7-3.0) and 2.0 (1.3-3.0), respectively. Being on sick leave was associated with shorter waiting time, adjusted RR of 1.7 (1.2-2.5). Referrals from within the hospital or other hospitals had also shorter waiting times than referrals from primary health care physicians, adjusted RR=1.4 (1.1-1.8). CONCLUSIONS: There was no evidence of bias against women or people in lower socioeconomic classes in this implicit queue management system. However, patients' access to inpatient surgery was associated with malignancy, prognosis, sick leave status, physician experience, referral pattern and the major diagnosis category.

Adolescent↗
PubMed2000

Design of a randomized controlled trial of comprehensive rehabilitation in patients with myocardial infarction, stabilized acute coronary syndrome, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting: Akershus Comprehensive Cardiac Rehabilitation Trial (the CORE Study).

OBJECTIVES: 1. To assess the long-term effectiveness of a comprehensive cardiac rehabilitation programme on quality of life and survival in patients with a large spectrum of cardiovascular diseases (myocardial infarction, acute coronary syndrome, percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). 2. To establish the degree of correlation between expected improvement of health-related quality of life and improvement in physical function attributable to rehabilitation in the intervention group, in comparison with similar changes in the conventional care group. DESIGN: Randomized, controlled, parallel-group design (intervention/conventional care). SETTING: Akershus County, southeast of Oslo City, Norway. PARTICIPANTS: 500 patients, men and women, aged 40-85 years, who have sustained at least one of the above-mentioned cardiovascular diseases. INTERVENTIONS: 8 weeks of supervised, structured physical training of three periods of 20 min per week, targeting a heart rate of 60-70% of the individual's maximum; home-based physical exercise training with the same basic schedule as in the supervised period; quantification of patients' compliance with the exercise programme by the use of wristwatches, information stored in the watch memory being retrieved once a month during the 3-year follow-up period; and life-style modification with an emphasis on the cessation of smoking and on healthy nutrition and weight control.

Journal Article↗